Abstract

e-Health has become a major focus for research in healthcare, with significant funding and political support at an international level. Older people stand to benefit more than others, as e-Health aims to facilitate provision of care at a distance and promote independent living for as long as possible. However, barriers remain including an immature evidence-base; questions about risk and safety; and variable rates of uptake in this population. This chapter explores these issues and reviews the literature on e-Health for older adults. Successful clinical trials are identified and the e-CAALYX project is described in detail as a case study. E-Health has presents many exciting opportunities but needs further development and guidance.

Healthcare For Older Adults

As this section of the population is expanding rapidly, there is a pressing need to redesign service provision. In particular, physicians have recognised that there is a much greater role to be played by preventive medicine. Traditionally healthcare has been concerned with treatment of disease rather than prevention, but increasingly there is a need to focus on how we can promote greater periods of healthy active living. Figure 1 shows the most common disease trajectories. Where once seniors experienced a short period of accelerated decline in their health towards the end of their lives, it is now more common to see a slow deterioration in function over several years. The “compression of morbidity” scenario is now changing to a situation where better treatment options ensure that chronic disease has a less progressive course. Sometimes this is associated with intermittent episodes of reduced function for a short period of time, which may be reversible with brief hospitalisations or a period of rehabilitation in a multidisciplinary environment.

Healthcare is not without its risks: in terms of encounters for each fatality it is more hazardous than driving, using a scheduled airline, or nuclear power (Commission on Systemic Interoperability, 2005). Typically 10% of inpatients are the victims of medical error (Leape, 1994). Hospitals harbour many pathogens and hospital-acquired infections are more common in older people. The development of specialty training for the care of older people is not widespread, and many older patients are treated by physicians without relevant specialist qualifications. This can lead to inappropriate interventions, or indeed under-treatment. Contact with physicians may in itself result in more prescriptions, and even community dwelling older adults take an average of 6 drugs (Barry, Gallagher, & Ryan, 2008). In short, healthcare does not always prioritise patient safety. It is this potential for adverse outcomes that has promoted the development of e-Health.